Download Thailand Diabetes Registry (TDR) Project: Clinical Status and Long

Thailand Diabetes Registry (TDR) Project: Clinical Status
and Long Term Vascular Complications
in Diabetic Patients
Petch Rawdaree MD*, Chardpraorn Ngarmukos MD**,
Chaicharn Deerochanawong MD***, Sompongse Suwanwalaikorn MD****,
Thanya Chetthakul MD*****, Sirinate Krittiyawong MD******,
Yupin Benjasuratwong MD*******, Pongamorn Bunnag MD**,
Natapong Kosachunhanun MD********, Nattachet Plengvidhya MD*********,
Rattana Leelawatana MD**********, Thongchai Prathipanawatr MD***********,
Supawadee Likitmaskul MD************, Sirima Mongkolsomlit BS*************
* BMA Medical College and Vajira Hospital
** Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
*** Rajavithi Hospital, ****Department of Medicine, Faculty of Medicine, Chulalongkorn University
***** Department of Medicine, Maharaj NakhornRatchasima Hospital, ****** Theptarin General Hospital
******* Department of Internal Medicine, Phramongkutklao Hospital
******** Department of Medicine, Faculty of Medicine, Chiang Mai University
********* Department of Medicine, Faculty of Medicine, Prince of Songkla University
********** Department of Medicine, Faculty of Medicine, Prince of Songkla University
*********** Deptpartment of Medicine, Faculty of Medicine, Khon Kaen University
************ Department of Pediatrics, Siriraj Hospital, Mahidol University
************* TDR research coordinator
Objective: The primary objectives of the Diabetes Registry project were to identify the characteristics of Thai
diabetic patients in tertiary care medical centers and to determine the extent of long term diabetic complications. The secondary objective aimed at building up and strengthening clinical research network among Thai
experts in diabetes mellitus and collection of baseline data for future follow-up study.
Material and Method: A cross-sectional, multi-center, hospital-based diabetes registry was carried out from
diabetes clinics of 11 tertiary centers. Demographic data, clinical status of diabetes and its complications
were collected and analyzed for the prevalence of complications and risk factors.
Results: Nine-thousand-four-hundred-and-nineteen patients were registered for the project and 94.6% were
type 2 diabetes. Mean SD of age was 59.4 13.5 and duration of diabetes was and 10 7.6 years. Only 38.2%
of the subjects achieved glycemic control of FPG under 130 mg/dl in only 30.7% had an HbA1c of less than 7%.
The overall prevalence of dyslipidemia found in this population was 73.3%, hypertension was 63.3% and
obesity (BMI > 25 kg/m2) was 52.6%. Diabetic nephropathy was the most common complication accounting
for 43.9% followed by retinopathy 30.7%, IHD 8.1% and cerebrovascular disease 4.4%
Conclusion: The prevalence of dyslipidemia and hypertension were high in this population, which may be
associated with the high prevalence of diabetic complications. The unsatisfactory control of metabolic status
may be due to aging and long duration of diabetic patients in this registry.
Keywords: Diabetes Registry, Thailand, Microvascular, Macrovascular complication, Dyslipidemia, Hypertension
J Med Assoc Thai 2006; 89 (Suppl 1): S1-9
Full text. e-Journal: http://www.medassocthai.org/journal
Correspondence to : Rawdaree P, Department of Medicine, Bangkok Metropolitan Medical College and Vajira Hospital, Samsen
Rd, Dusit, Bangkok 10300, Thailand. Phone: 0-2244-3490, E-mail: [email protected]
J Med Assoc Thai Vol. 89 Suppl. 1 2006
S1
Diabetes Mellitus is epidemic worldwide
owing to the increasing number of aging population
and globalization. The WHO predicted a doubling
number of diabetic patients in the next twenty years
especially in developing countries in Asia(1). Increased
calorie intake and sedentary lifestyle are prerequisites
to abdominal obesity underpin the development of
diabetes mellitus(2).
Thailand is inevitably moving towards the
burden of such a public health problem. According to
the cross country survey in the InterAsia study, the
prevalence of type 2 diabetes in Thailand was 9.8
percent, which was doubling the number forecast by
the WHO(3). Hyperglycemia obviously causes diabetic
retinopathy and nephropathy, the microvascular complications that are the leading causes of blindness
and chronic renal failure.
In addition to hyperglycemia itself, diabetic
patients also bring other components of the so called
metabolic syndrome, i.e., hypertension, dyslipidemia,
abdominal obesity and the consequent cardiovascular
diseases(4). Both microvascular and macrovascular
complications are the burden of the disease not only
in terms of individual health and well-being but also
in having an impact on the economic status of their
families and the country.
Unfortunately, the authors do not have their
own data regarding the extent and impact of the disease
in Thai population, which is essential for making a
decision and budget allocation of the policy makers.
In resource limited countries, appropriate allocation is
very important. Inappropriate budget allocations have
a huge impact on nearly all sectors of people.
The Clinical Research Cooperation Network
(CRCN) supported by the Health System Research
Institute (HSRI), initiates the multicenter cooperation
of experts in diabetology to carry out a study to get the
true picture of diabetes mellitus in Thailand. This cooperation aimed at capacity building to undertake a
multicenter clinical study and strengthening research
networks among medical institutions, as well as developing invaluable information on the status of diabetes
mellitus in Thailand. The Diabetes Registry Project
under the Thailand Endocrinology Society, supported
by the CRCN and funded by HSRI, was established in
2003 to accomplish the afore-mentioned missions.
Objectives
The primary objectives of the Diabetes
Registry project were to identify the characteristics of
Thai diabetic patients in tertiary care medical centers
S2
and to determine the extent of long term diabetic
complications, which are expected to differ from other
countries. The secondary aim of this project was to
build up and strengthen a clinical research network in
Thailand, especially experts who are interested in
research into diabetes mellitus. Finally, the primary data
collected in the registry will be baseline information
for upcoming research into various aspects of diabetes in Thailand.
Material and Method
Population and sampling
Eleven tertiary care medical institutes participated in the present project, all of which have diabetic
clinics in their hospitals. Inclusion criteria of the subject were any diabetic patients who were expected to
contact the clinic for the consecutive year. The diagnosis of diabetes mellitus was made according to the
American Diabetes Association (ADA) criteria 1997(5),
i.e fasting plasma glucose being > 126 mg/dl more than
2 times or plasma glucose after 2 hours being > 200 mg/
dl. The authors excluded only the subjects who were
unable to communicate or give medical information to
the investigators. The sample size was calculated based
on ability of the study to detect a significant number of
diabetic retinopathy, microvascular complications
directly related to the natural history of diabetes mellitus. A previous study in 2,060 patients with type 2
diabetes reported that the prevalence of diabetic
retinopathy was 32%. The authors expected 1% error
(e) to detect diabetic retinopathy with a 95% confident
interval for the sample size calculation using the
following formula:
n=
Zα2 / 2 P(1 − P)
e2
The sample size was at least 8,360 subjects.
Purposive sampling methods were employed to recruit
those who met the criteria and the numbers of subjects
enrolled from each site, based on the capability of each
institute as shown in Table 1.
A cross-sectional, multi-center, hospital-based
diabetes registry was carried out from April 2003 to
December 2003 and 9,419 diabetic patients registered.
Type of diabetes was categorized in the
present study as: (1) type 1 diabetes (T1DM) if they
required insulin for glycemic control and prevention of
diabetic ketoacidosis; (2) type 2 diabetes (T2DM) for
subjects who used oral antidiabetic agents and had no
history of diabetic ketoacidosis; (3) specific type of
J Med Assoc Thai Vol. 89 Suppl. 1 2006
Table 1. Numbers of subjects from the 11 participating medical centers
Institute
1
2
3
4
5
6
7
8
9
10
11
Number of subject
Rajavithi Hospital
Chulalongkorn Hospital
Maharaj Nakhon Ratchasima Hospital
Vajira Hospital
Theptarin General Hospital
Phramongkutklao Hospital
Ramathibodi Hospital
Maharaj Nakorn Chiang Mai Hospital
Siriraj Hospital
Songklanakarindh Hospital
Khon Kaen University Hospital
1412
1110
1066
997
964
956
843
675
621
525
250
Total
9419
diabetes such as maturity onset diabetes in the young
(MODY); and (4) uncertain type.
Medical history and socioeconomic status
were gathered and interviewed by research nurses.
Physical examination including body weight, height,
dorsalis pedis and/or posteria tibialis pulse, foot ulcer
and amputation were done by endocrinologists on the
date of registry. Blood pressure was measured twice,
at least 1 minute apart, by automated blood pressure
machine (Omron T4). Mean values of both systolic
and diastolic blood pressure were used to define blood
pressure levels. Hypertension was defined by mean
blood pressure levels equal to or more than 140/90
mmHg or the use of antihypertensive agents. Eyes
examinations were done by ophthalmologists within
the past 12 months or within the next 3 months after
registry. The diagnoses of cardiovascular diseases were
based on clinical diagnosis documented in medical
records. The details of diabetic complications were
described in specific articles in this journal. The recent
use of antidiabetic agents and other medications
related to diabetes such as antihypertensive agents,
lipid lowering agents and antiplatelets were retrieved
from the medical records.
Laboratory results reported in the registry were
collected from routine examinations of the institutes’
clinical care which had been tested with the past 6
months or in the following 3 months after registration.
The most recent results of fasting plasma glucose,
HbA1c level, and lipid profile were recorded in the
case record form. Dyslipidemia was defined as having
serum cholesterol more than 200 mg/dl, triglycerides
more than 150 mg/dl, HDL-cholesterol less than 40 mg/
dl or recent use of lipid lowering agents. Nephropathy
J Med Assoc Thai Vol. 89 Suppl. 1 2006
was defined when the patient had at least one of the
following; positive microalbuminuria within one year
that was confirmed by elevated urine microalbumin
levels in at least two of the three collections; positive
proteinuria that was defined as a positive urine dipstick test at least 1+ level; renal insufficiency defined
when serum creatinine level was equal or more than 2
mg/dl. Patients without nephropathy were defined
when they had negative urine microalbumin.
The present study was approved by the
ethics committee of each participating hospital. Signed
informed consent was obtained from all participants.
Data collection
A data collection form was developed according to the primary objective of the present study.
Training of researchers and research assistants was
done during a pilot data collection period and case
record form was standardized. Site visits by internal
and external auditors were done regularly to assure
quality of the data and the process. Data from all
participant institutes was sent to the project center
for double entry into the data base server and data
cleaning was done by a research coordinator and a
consultant statistician.
Statistical analysis
Demographic data were expressed as mean ±
SD. Statistical analyses were performed using STATA
version 8.0 (Stata Corporation, College Station TX, U.S.)
Comparisons between groups were analyzed by
unpaired t-test, Mann Whitney U. test, Chi-square test
or Fisher’s exact test, where appropriate. Prevalence of
complications was described in percentage with 95%
S3
Ph D
0.4%
Master
3.2%
Bachelor
14.4%
Vocational
8.2%
Secondary
school
19.6%
Primary
school
45.1%
None
9.1%
0
10
Student
20
30
40
50
1.9%
Professional
14.8%
Skilled worker
5.6%
House wife
26%
Labor
16.3%
Unemployed
35.4%
0
Welfare card
10
20
30
40
1.6%
Private insurance
0.6%
Universal coverage
8.5%
Social security
5.7%
Gov. employed
55.9%
Self payment
27.7%
0
10
20
30
40
50
60
Fig. 1 Socioeconomic status of diabetic patients
S4
J Med Assoc Thai Vol. 89 Suppl. 1 2006
confidence intervals (95% CI). Statistical significance
was declared if p-value was less than 0.05.
Table 2. Age group and duration of all subjects
Characteristic
Results
Eleven medical centers enrolled 9,419 diabetic
patients in the present study and 65.9% were female.
Age of the participants ranged from 1.6 to 96.4 years
with 58.8% of them aged between 50 to 70 years and
the mean age was 59.4 ± 13.5 years. Most of the subjects,
35.4% were unemployed, and 26.0% were housewives.
Forty-five percent of the patients had primary school
education and 18% had received a bachelor degree or
higher. Most of the patients, 55.9%, were reimbursed
for their medical expenses by the government as civil
service welfare (Fig. 1).
The mean duration of diabetes was 10 ± 7.6
years and 38.9% had diabetes for more than 10 years as
shown in Table 2. The majority (94.6%) of the patients
was diagnosed as having T2DM, and the rest were
T1DM 4.5%. Only 6 cases (0.1%) were MODY. Family
history of diabetes in their first degree relatives was
observed in 53.7% of the participants. Of those, 11.7%
was in mothers only, 6% in fathers only and 2.4% in
both fathers and mothers. There was a higher family
history of diabetes in female than in male siblings,
9.4% and 5.1% respectively.
According to the ADA guideline of metabolic
control for diabetic patients(5), the mean fasting plasma
glucose level was 153.6 ± 56.7 mg/dl and 38.2% of the
subjects had Fasting Plasma Glucose (FPG) less than
130 mg/dl, while mean HbA1c was 8.2 ± 1.9% and 30.7%
of the patients had HbA1c level of lower than 7% as
Age group (years)
< 10
11-20
21-30
31-40
41-50
51-60
61-70
71-80
> 80
Duration of diabetes (years)
<1
1-5
6-10
11-15
16-20
> 20
Unknown
Number
(n = 9419)
Percent
53
135
135
455
1341
2566
2968
1525
241
0.6
1.4
1.4
4.8
14.2
27.3
31.5
16.2
2.5
408
2619
2709
1676
1082
906
19
4.3
27.8
28.8
17.8
11.5
9.6
0.2
shown in Fig. 2. For lipid profile, mean total cholesterol, triglycerides, LDL-C and HDL-C levels were 197
± 43, 151 ± 105, 115 ± 36, and 54 ± 15 mg/dl respectively.
Achievement to the ADA guideline for cholesterol,
triglycerides, LDL-C and HDL-C were 33.8, 37.2, 36.7
and 67.8% respectively. In the aspect of the Metabolic
Syndrome, the overall prevalence of dyslipidemia was
73.3%, hypertension was 63.3%, and obesity (BMI >
25 kg/m2) was 52.6%.
Fig. 2 Percent achievements of metabolic control according to the ADA guideline 2005
J Med Assoc Thai Vol. 89 Suppl. 1 2006
S5
Fig. 3
Prevalence of long term diabetes complications
The most common diabetic complication was
nephropathy at 43.8%, followed by diabetic retinopathy
at 30.7%. In terms of macrovascular complications, the
prevalence of ischemic heart disease was 8.1% followed
by cerebrovascular disease at 4.4%. The prevalence of
amputation was only 1.6%, but if the authors took into
account foot ulcer and absence of peripheral pulse as
peripheral vascular disease this prevalence increased
to 11.4% (Fig. 3). The prevalences of all complications
were higher in type 2 diabetes than those in type 1 as
Table 3. Number (%) of diabetic complications in type 1 and type 2 diabetes
Complications
Nephropathy
Total number
Microalbuminurea
Proteinurea
Serum creatinine > 2 mg/dl
No nephropathy
Retinopathy
Total number
Non-proliferative
Proliferative
No retinopathy
Ischemic heart disease
Total number
Definite
Possible
No ischemic heart disease
Cerebrovascular disease
Total number
Ischemic stroke
Hemorrhagic stroke
Undefined cause
No cerebrovascular disease
S6
Type 1 DM (%)
Type 2 DM (%)
Total (%)
207 (100)
31 (15.0)
41 (19.7)
20 (9.7)
115 (55.6)
4874 (100)
879 (18.0)
866 (17.8)
402 (8.3)
2727 (55.9)
5131 (100)
915 (17.8)
915 (17.8)
423 (8.3)
2878 (56.1)
347 (100)
38 (10.9)
37 (10.6)
272 (78.5)
6707 (100)
1474 (22.0)
629 (9.4)
4604 (68.6)
7119 (100)
1516 (21.3)
671 (9.4)
4932 (69.3)
421 (100)
4 (0.9)
3 (0.7)
414 (98.4)
8851 (100)
398 (4.5)
353 (4.0)
8100 (91.5)
9353 (100)
403 (4.3)
358 (3.8)
8592 (91.9)
424 (100)
6 (1.4)
0
0
418 (98.6)
8993 (100)
320 (3.6)
39 (0.4)
48 (0.5)
8586 (95.5)
9419 (100)
326 (3.5)
39 (0.4)
50 (0.5)
9004 (95.6)
J Med Assoc Thai Vol. 89 Suppl. 1 2006
shown in Table 3, with one exception. Diabetic nephropathy was found in equal percentage in both types of
diabetes.
Discussion
Because this Diabetes Registry Project has
been undertaken in a period of only 6 months, the
authors could not recruit all diabetic patients from each
center. However, 9,419 subjects are enough to study
patients’ characteristics and measure the burden of the
complications in the presented diabetic patients. More
female subjects were enrolled in the registry accounting for 69.5%. This is higher than the prevalence of
Thai female diabetes in a previous report and in other
Asian populations(6).
Socioeconomic status to some extent may
affect diabetic complications and mortality as described
in a study done in the United Kingdom(7). They found
that the mortality rates in type 2 diabetes were
higher for those who left school before 16 years of age
compared to those who left school at or after 16 years
of age (OR 2.86, CI 1.93-4.25). Subjects who were
unemployed had a higher mortality rate than those
employed (OR 2.88, CI 2.12-3.91). In the present study
the authors found that 35% of the patients were
unemployed and nearly half of them had only primary
school or lower education. This finding would be taken
into consideration not only for diabetes care, but also
for standard of living.
The higher mean age of 59 years and longer
duration, 10 years of diabetes contributed to a high
prevalence of diabetic complications, especially
microvascular complications that are directly related
to duration of the disease(8,9). It is well established
that microvascular complications, diabetic retinopathy
and nephropathy, are related to degree of glycemic
control(10). Even in this cross sectional data, 70% of
the patients did not achieve the ADA guidelines of
FPG and HbA1c. This leads to a huge number of
diabetic nephropathy and retinopathy. Compared with
the macrovascular complications, the higher prevalence
of microvascular complications may be due to diagnosis criteria of the present study, but this is comparable
to a previous report(10). Microvascular complications
were mostly diagnosed using screening tests such as
urine microalbuminuria and retinal examination by
ophthalmologists in asymptomatic stage while cardiovascular diseases were diagnosed only in full-blown
subjects. Comparison regarding the prevalence of
diabetic complications in Table 3 shows that diabetic
nephropathy is higher in type 2 diabetic subjects
J Med Assoc Thai Vol. 89 Suppl. 1 2006
probably due to the other factors consisting of hypertension and dyslipidemia. These are related to the
renal complications and are more aggregated in T2DM
patients with increasing age.
The prevalence of ischemic stroke being 4
times higher than that of hemorrhagic stroke, is not
different from another study in an Asian population(11).
In addition, the authors found that the prevalence of
stroke was 4.4%, which was lower than that of 10% in
coronary heart diseases. This finding is the same as
found in other Asian populations, but is different from
that found in the European populations(12). This may
be due to a lower level of HDL-cholesterol in the
Asian population. However, it may be due to selection
bias of this present study that excluded patients who
had a communication disability. Nonetheless, wellestablished risk factors are quite high such as dyslipidemia at 73% and hypertension at 63%. They may
increase the incidence of diabetic complications in the
future. A follow-up study for incident cases of this
cohort will give more precise information.
Achievement of glycemic control and metabolic derangement is another important issue to mention in this present registry. The authors found that
glycemic control achieved the target in only 30% of the
patients, and LDL-C of being less than 100 mg/dl was
achieved in only 38.1% of all patients regardless of any
treatment strategies; all of those accounted for macrovascular diseases. This achievement is similar to the
average achievement as studied by the DiabCare Asia
that is in between 20 to 30%, according to the countries(13). If the authors regard that annual screening for
diabetic complications is an indicator for standard of
care, 2300 out of 9419 cases (24.4%) did not undergo
eye examinations by ophthalmologists in the past
year. The inadequate eye examination is clearly due to
a limited number of ophthalmologists as found in a
study in Nakhonrajasrima province showing that eye
examinations could be done in only 23.5% of diabetic
patients(14). Screening for diabetic nephropathy may
be more serious in this patient population since nearly
a half of the patients in the present registry had not
been tested for urinary microalbuminuria and the
authors found that 41% of the screened subjects had
diabetic nephropathy. The large number of unscreened
cases is due to financial limitation.
The present study recruited nearly 10,000
diabetic patients. This is a large enough sample size to
see the characteristics and burden of diabetic complications in the Thai population. Even though the present
study was done in tertiary care medical centers, that
S7
may be different from those in a primary care situation,
the authors might be able to forecast the magnitude of
the problem related to diabetes in Thailand.
Acknowledgements
The present study was supported by the
Health Systems Research Institute, Thailand and the
Endocrine Society of Thailand. The authors wish to
thank the Clinical Research Cooperation Network who
fostered this project. The authors wish to thank the
staff and nurses in every center for their contribution.
Lastly, the authors wish to thank our senior consultants
Prof. Sathit Vannasaeng, Prof. Gobchai Puavilai and
Dr. Chulaluk Komontri for invaluable advice.
Appendix
TDR Working Group:
The following persons participated in the
Thailand Diabetic Registry:
BMA Medical Collage and Vajira Hospital:
Petch Rawdaree, Natee Munskul, Swangjit Suraamornkul, Petcharapan Tiyamanee, Sirima Mongkolsomlit
Rajavithi Hospital: Chaichan Deerochanawong, Pattraporn Kornthong
Chiang Mai University: Natapong Kosachunhanun, Ampica Mangklabruks, Kaset Chimplee,
Laddawan Limpijarnkit
Prince of Songkla University: Chatchalit
Rattanasarn, Rattana Leelawatana Supamai Soonthornpun, Worawong Setasuban, Atchara Thamprasit
Chulalongkorn University: Sompongse
Suwanwalaikorn, Apaporn Garin, Suttipong Wacharasindhu
Theptarin General Hospital: Thep Himathongkam, Sirinate Krittiyawong, Kanokporn Imsakul
Khon Kaen University: Thongchai Pratipanawatr, Chatlert Pongchaiyakul, Ratchanee Chotmongkol
Maharat Nakhon Ratchasima Hospital:
Thanya Chetthakul, Puntip Tantiwong, Rittha
Lertkhunluk, Linchong Kantisophon, Narin Methanuwat, Daungpen Nararuk, Wasana Klomkratoke
Phramongkutklao Hospital: Yupin Benjasuratwong, Ampar Suthijumroon, Somchai Pattanaungkul
Ramathibodi Hospital, Mahidol University:
Gobchai Puavilai, Boonsong Ongphiphadhanakul,
Pongamorn Bunnag, Chardpraorn Ngarmukos,
Boonchan Wongsunopparat
Siriraj Hospital, Mahidol University: Sathit
Vannasaeng, Nattachet Plengvidhya, Supawadee
Likitmaskul, Chulaluk Komontri, Pornpimaol Kiattisakthavee, Katharee Chaichanwatanakul
S8
References
1. King H, Aubert RE, Herman WH. Global burden of
diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998; 21:
1414-31.
2. Bajaj M, Banerji MA. Type 2 diabetes in South
Asians: a pathophysiologic focus on the AsianIndian epidemic. Curr Diab Rep 2004; 4: 213-8.
3. Aekplakorn W, Stolk RP, Neal B, Suriyawongpaisal
P, Chongsuvivatwong V, Cheepudomwit S, et al.
The prevalence and management of diabetes in
Thai adults: the international collaborative study
of cardiovascular disease in Asia. Diabetes Care
2003; 26: 2758-63.
4. Eckel RH, Grundy SM, Zimmet PZ. The metabolic
syndrome. Lancet 2005; 365: 1415-28.
5. Standards of medical care in diabetes. Diabetes
Care 2005; 28(Suppl 1): S4-36.
6. Qiao Q, Hu G, Tuomilehto J, Nakagami T, Balkau B,
Borch-Johnsen K, et al. Age- and sex-specific
prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. Diabetes Care 2003; 26:
1770-80.
7. Robinson N, Lloyd CE, Stevens LK. Social deprivation and mortality in adults with diabetes mellitus. Diabet Med 1998; 15: 205-12.
8. Harris MI. Undiagnosed NIDDM: clinical and
public health issues. Diabetes Care 1993; 16: 642-52.
9. Klein R, Klein BE, Moss SE, Davis MD, DeMets
DL. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy.
JAMA 1988; 260: 2864-71.
10. Klein R, Klein BE, Moss SE, Davis MD, DeMets
DL. The Wisconsin epidemiologic study of diabetic
retinopathy. II. Prevalence and risk of diabetic
retinopathy when age at diagnosis is less than 30
years. Arch Ophthalmol 1984; 102: 520-6.
11. Stroke epidemiological data of nine Asian countries.
Asian Acute Stroke Advisory Panel (AASAP). J
Med Assoc Thai 2000; 83: 1-7.
12 Chowdhury TA, Lasker SS. Complications and
cardiovascular risk factors in South Asians and
Europeans with early-onset type 2 diabetes. QJM
2002; 95: 241-6.
13 Chuang LM, Tsai ST, Huang BY, Tai TY. The status of diabetes control in Asia - a cross-sectional
survey of 24 317 patients with diabetes mellitus in
1998. Diabet Med 2002; 19: 978-85.
14 Nitiapinyasakul N, Nithiapinyasakul A, Chettakul
T. Diabetic retinopathy screening in community
hospitals. Thai J Ophthalmol 2004; 18: 103-10.
J Med Assoc Thai Vol. 89 Suppl. 1 2006
โครงการลงทะเบียนผู้ป่วยเบาหวานในประเทศไทย: ลักษณะทางคลินิกและความชุกของภาวะ
แทรกซ้อนระยะยาวทางระบบหลอดเลือด
เพชร รอดอารีย,์ ฉัตรประอร งามอุโฆษ, ชัยชาญ ดีโรจนวงศ์, สมพงษ์ สุวรรณวลัยกร, ธัญญา เชฏฐากุล,
สิรเิ นตร กฤติยาวงศ์, ยุพนิ เบ็ญจสุรตั น์วงศ์, พงศ์อมร บุนนาค, ณัฐพงศ์ โฆษชุณหนันท์, ณัฐเชษฐ์ เปล่งวิทยา,
รัตนา ลีลาวัฒนา, ธงชัย ประฏิภาณวัตร, สุภาวดี ลิขติ มาศกุล, สิรมิ า มงคลสัมฤทธิ์
วัตถุประสงค์: เพื่อศึกษาลักษณะและปัญหาเกี่ยวกับภาวะแทรกซ้อนของผู้ป่วยเบาหวานที่เข้ารับการรักษาใน
โรงพยาบาลตติยภูมิหลายสถาบันในประเทศไทย และเพื่อเป็นการสร้างเครือข่ายการวิจัยทางคลินิกและฐานข้อมูล
ผู้ป่วยเบาหวานเพื่อการวิจัยในอนาคต
วัสดุและวิธีการ: การศึกษานี้เป็นการลงทะเบียนผู้ป่วยเบาหวานที่มารับการรักษาที่คลินิกเบาหวานของโรงพยาบาล
ระดับตติยภูมิทั้งหมด 11 แห่ง มีการเก็บข้อมูลด้านประวัติ, การตรวจร่างกายและการตรวจเลือดเพื่อหาความชุกของ
โรคแทรกซ้อน การบรรลุเป้าหมายในการรักษาโรคเบาหวานและความผิดปกติที่พบร่วม
ผลการศึกษา: มีผปู้ ว่ ยจำนวนทัง้ สิน้ 9,419 ราย จากโรงเรียนแพทย์และสถาบันในระดับตติยภูมิ 11 สถาบัน ในช่วงปี
พ.ศ. 2546 จากข้อมูลในภาคตัดขวางพบว่าผูป้ ว่ ยร้อยละ 94.6 เป็นเบาหวานชนิดที่ 2 มีอายุเฉลีย่ 59.4 ±13.3 ปี และ
เป็นเบาหวานมานานเฉลี่ย 10 ±7.6 ปี ผู้ป่วยมากกว่าร้อยละ 50 ได้รับการศึกษาในระดับประถมหรือต่ำกว่า และ
ส่วนใหญ่เป็นผู้ว่างงาน ผู้ป่วยสามารถควบคุมระดับน้ำตาลในเลือดได้ตามเป้าหมายร้อยละ 38.2 และระดับ HbA1c
ถึงเป้าหมายร้อยละ 31.7 นอกจากนีย้ งั พบว่า มีโรคความดันโลหิตสูงและไขมันผิดปกติในเลือดสูง ร้อยละ 63.3 และ
73.3 ตามลำดับ โรคแทรกซ้อนส่วนใหญ่ทพ่ี บเป็นในระบบหลอดเลือดขนาดเล็กทีต่ า ร้อยละ 30.7 ทีไ่ ต ร้อยละ 43.9
และพบมีโรคแทรกซ้อนในหัวใจและสมองร้อยละ 8.1 และ 4.4 ตามลำดับ
สรุป: ผูป้ ว่ ยในกลุม่ นีม้ อี ายุเฉลีย่ สูง และเป็นโรคเบาหวานมานาน ทำให้พบมีความผิดปกติอน่ื ร่วมด้วยมาก นอกจากนี้
ยังพบว่าการควบคุมระดับน้ำตาลในเลือดและเมตาโบลิสมทำได้ไม่ดี จึงเกิดโรคแทรกซ้อนได้มาก โดยเฉพาะทีพ่ บมาก
ในโครงการนี้คือทางระบบหลอดเลือดเล็กที่ไตและที่จอประสาทตา
J Med Assoc Thai Vol. 89 Suppl. 1 2006
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